North Carolina’s infant mortality rate decreased to 7.1 deaths per 1,000 births, compared with a 2016 rate of 7.2 and a 2015 rate of 7.3, according to the North Carolina Department of Health and Human Services' 2017 infant mortality rates. While the racial disparity between birth outcomes for white infants and African-American infants remains unacceptably high, there was a reduction in the gap in birth outcomes.
Infant mortality is driven by a wide range of factors, including access to health care before, during and after pregnancy. Medical conditions, such as obesity and substance use disorders, can also play a role, as can non-medical factors like food insecurity, domestic violence, poverty and racism.
“Though the trend is positive, these numbers show how much more work is left to be done,” said State Health Director and DHHS Chief Medical Officer Elizabeth Tilson, M.D., MPH. “DHHS is committed to doubling down its focus on this critical area to lower North Carolina’s overall rate and to decrease our unacceptable racial disparities in infant mortality.”
African-American infants still die at more than twice the rate of white infants; however, there was slight improvement in the disparity. In 2017, the mortality rate for white infants was 5.0 deaths per 1,000 births, the same rate as 2016. The 2017 mortality rate for African-American infants was 12.5, down from 13.4 in 2016. Because of the reduction in the African-American infant death rate, the 2017 Infant Mortality Disparity Ratio decreased from 2.68 in 2016 to 2.5 in 2017. Persistent disparities also continue in birth outcomes between American-Indian and white women.
“A woman’s pregnancy is a relatively short time and it is an insufficient amount of time to correct health-related or social issues that have been occurring for a lifetime, or even generations,” said Dr. Kelly Kimple, chief of the Division of Public Health’s Women’s and Children’s Health Section. “We must work to improve the health of women throughout their lives and support fathers and families to continue to see an increase in the number of healthy mothers and babies.”
North Carolina has developed and implemented multiple strategies to address infant mortality and the underlying drivers of health. North Carolina’s Pregnancy Medical Home Program, inclusive of Pregnancy Care Management, was recently recognized nationally as an initiative in improving infant and maternal health outcomes.
DHHS and its partners are also in the midst of implementation of the five-year N.C. Perinatal Health Strategic Plan, launched in March 2016. The plan was designed by experts from across North Carolina and guided by a core group of perinatal health leaders. In 2016, a maternal mortality review committee was formed, and earlier this year, the Office of Minority Health and Health Disparities released a North Carolina Health Equity Report to guide planning.
Additionally, DHHS was directed by Governor Roy Cooper in August 2018 through Executive Order 49 to lead the development of a statewide Early Childhood Action Plan with support from the Early Childhood Advisory Council and other stakeholders from across the state. A decrease in the statewide disparities in infant mortality is one of the plan’s goals.
The plan addresses important factors such as increased access to preventive health services, safe and secure housing, building nurturing relationships within families, and improving food security, among others. A draft was released for public feedback on Nov. 1 and the final plan will be released in early 2019.
The 2017 infant mortality data can be found at: www.schs.state.nc.us/data/vital/ims/2017.